Summer Sports Registration Form

Summer Sports Registration Form

Its a sport registration form for a small event. This form asks basic personal information, health information and other related questions about sports experience. Form Preview
  • Summer Registration - Mini Camp June 17th-18th, 2015

  • Camper Name

  • Camper's Information

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  • T-Shirt Size

  • Parent or Legal Guardian Information

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  • Email Confirmation

  • Other Information

  • Health Information

  • It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury.  If the information has changed on the day of registration please see a camp administratior.  

  • All fileds are required below.  If nothing applies, please put "NONE" in the box.  Thanks.

  • Medical Release.

    I, on my own behalf and on behalf of the minor, acknowledge and agree that such participation subjects Minor to possibility of physical illness or injury (minimal, serious, catastrophic and/or death) and that I, on my own behalf and on behalf of the Minor, acknowledge that the Minor is in good health, physically fit and mentally capable of participating in Camp activities, and is covered by accident and health insurance, and I hereby give full approval for my child’s participation in the Camp. In the event of such illness or injury, I authorize Piedmont Camps NC to obtain necessary medical treatment of the Minor and hereby, on my own behalf and on behalf of the Minor, release and hold harmless Releasees in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related bills that may be incurred on behalf of the Minor for any illness or injury that the Minor may sustain during the Camp and while traveling to and from the site for the Camp.

  • Payment Information

    $125 Registration Fee Due

  • Enter coupon

  • If paying with PayPal you will be redirected to PayPal once you hit submit.  You can either pay with credit card, or PayPal.  There is a $3.50 processing fee for using this option.   If paying with a check, please send the registration fee as soon as possible.  You can pay multiple registration fees with one check.  In memo, please put the camper(s) name.  If you have any questions feel free to contact

  • Camper Release

    • Be certain to enter your email address  correctly on the registration form to receive confirmation via email with in 2 weeks
  • Camp Rules. I further acknowledge and understand that Piedmont Camps NC have established rules and regulations pertaining to conduct, behavior and activities of all Camp participants by which Minor and I agree to abide during the Camp), and that Minor and I will be responsible for his/her/my failure to abide by those rules and regulations. Minor and I have received, read and understand the Camp rules. Minor and I understand that violation of the rules can result in dismissal from Camp.

    By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18.  In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel.   I understand that the above named camper will only be released to the names listed above, an update may be done at registration.  I certify that my child has my permission to attend camp and participate in all activites.  I authorize Piedmont Camps NC to use my camper's picture, testimony, and video in any promotional material(web,print,or media) I may recieve any e-mails from the camp.  

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